Failure to Report Alleged Abuse to State Agency
Penalty
Summary
The facility failed to immediately report an allegation of verbal and physical abuse involving a resident to the Office of Long-Term Care (OLTC). The incident involved a resident with mild cognitive impairment, anxiety disorder, and psychophysiologic insomnia, who was assessed as cognitively intact with a BIMS score of 13 and no history of behavioral issues or false accusations. The resident alleged that two CNAs pushed their shoulder into the wall and verbally abused them after an episode of incontinence, but was unable to identify the alleged perpetrators. The incident was discovered by the ADON and reported to the police, who found no witnesses or physical signs of abuse. Despite the allegation, the facility's internal investigation concluded there was no evidence to support the claim, and the family was informed and satisfied with the results. Interviews with the ADON, Administrator, and DON revealed that the incident was not reported to the State Agency, as they believed their internal investigation was sufficient and the claim was unsubstantiated. The Medical Director also agreed that reporting to the State Agency was unnecessary due to the lack of findings from the internal investigation.